Table 3.
Initial Staging and Laboratory Work-up
| Mandatory | Optional/Depending on Suspicion | |
|---|---|---|
| Cross-sectional imaging | MRI or CT (abdomen/pelvis/chest) | [18F]FDG-PET scan, bone scan |
| Hormonal work-up | Blood: DST, 8:00 am cortisol and ACTH, DHEAS, testosterone (total or bioavailable), aldosterone and renin, metanephrine and normetanephrinea (to exclude pheochromocytoma), 24-h urine: free cortisolb | Blood: 17-OH-progesterone, 17-OH-pregnenolone, 11-deoxycorticosterone, progesterone, androstenedione, estradiol, FSH, LH |
| Other laboratory work-up | Discuss testing for TP53 mutations; AST, ALT, creatinine, lipid profile, TSH, free T4, CBC | Alkaline phosphatase, GGT, other laboratories |
Abbreviation: CBC, complete blood count.
a
Either 24-hour urine or plasma free metanephrines.
b
If 1 mg DST suggests hypercortisolism.